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Students on placement are not counted as part of the workforce, but after the disruption caused by COVID-19, some fear the status is under threat
As a nursing student, half your learning time is spent on clinical placements, where you have supernumerary status.
Nursing Standard. 37, 7, 24-25. doi: 10.7748/ns.37.7.24.s15
Published: 06 July 2022
This status means you cannot be counted as part of the workforce, but instead are treated as an additional staff member on the basis that you are undertaking a placement to learn.
This does not mean that you do not work while on placement – students are expected to learn through supervised participation in clinical work, with the level of supervision dependent on your stage of training and previous experience.
Nursing and Midwifery Council (NMC) standards for preregistration nursing programmes make it clear that placements should enable nursing students to learn to provide safe and effective care. Students are not merely there to observe, the guidance says, but ‘can and should add real value to care’.
Supernumerary status is designed to give nursing students the space and time to learn and understand their professional responsibilities.
The RCN argues that counting nursing students as part of the workforce would mean them being used as support staff and would be unable to develop the skills and competencies necessary to deliver safe and effective care.
In its position statement on the issue, the RCN says there is a risk that without supernumerary status, patient care would be compromised.
‘There are multiple factors why students are struggling to get quality placements’
Rachel Wood, RCN professional lead for nursing students
When all students are supernumerary, it is clear to other staff that they are primarily there to learn. This makes it easier for students to articulate their learning needs more confidently and to access the appropriate clinical activities and experiences.
At RCN congress in Glasgow last month, student leaders urged RCN council to use its influence to lobby for the protection of supernumerary status for nursing students, who fear it is under threat.
RCN professional lead for nursing students Rachel Wood says this stems from the fact that it is getting difficult to access good quality clinical placements, with some nursing students even finding they have not done enough hours by the time they finish their courses.
‘There are multiple factors why students are struggling to get quality placements,’ she says. ‘We had a nursing shortage going into the pandemic, which was affecting placement quality, but what we have seen over the past two years has exacerbated that.
‘High levels of sickness or the requirement to isolate during COVID have significantly affected placement capacity and learning opportunities for students while on placement. In some cases, students are unable to complete the required placement hours in time and so are having to continue beyond their expected completion date, which has significant financial and logistical implications.
‘It leaves them in the difficult position of trying to make up their practice hours when they may no longer be entitled to student finance but cannot start earning.’
Ms Wood says addressing the issue will be challenging. ‘It is hard to say how widespread this is, but we are calling for RCN council to campaign and work with others to protect supernumerary status. It is a result of a lack of workforce planning over many years, so it is not going to be easy.’
In the meantime, she says there are several steps nursing students can take themselves. ‘If students are concerned about their clinical placements, in the first instance we recommend raising it with their practice assessor,’ says Ms Wood.
‘If it is not resolved, they can raise it with the university or the RCN through the student ambassador at their university.’
During the first wave of COVID-19 in spring 2020, emergency standards introduced by the NMC meant nursing students from all four UK countries had the choice to opt in to an extended clinical placement, forfeiting their supernumerary status in return for monthly payments.
The scheme was suspended in September 2020 but was reintroduced for a period in early 2021 as COVID-19 infections surged again.
London South Bank University professor of healthcare and workforce modelling Alison Leary believes the pandemic has ‘blurred already-blurred lines’.
‘I frequently get messages from students who are asked to work rather than learn,’ she says. ‘Nursing praxis is developed by experiencing, not just watching, but I am disappointed by the number of nurse leaders I see on social media who think students should act as unpaid labour and “muck in” when it’s busy.
‘There is a staffing crisis, but we will not solve that by giving students poor experiences of work – the attrition rate is already high.’
James Savage graduated from his mental health nursing degree at Liverpool John Moores University in March and works in a women’s inpatient mental health unit for Mersey Care NHS Foundation Trust
‘There has been so much disruption during the pandemic,’ he says ‘I would have liked to have done a child mental health placement, but I did not get to do one. I also had to do a simulated placement. It was only a small stint so did not affect me greatly, but I know some universities are doing them in big blocks. I have also heard that some placements are just being done on Teams.
‘Areas like mental health are so therapeutic and intervention based – you cannot do that virtually, it is simply not as good as an in-person placement.
Quality of placement affected
‘The other issue was that we had periods during the pandemic where nursing students were paid and not treated as supernumerary, which blurred the lines,’ he says. ‘There were students on placement alongside paid nursing students – what they could and could not do and the level of supervision was different, which created confusion for staff and affected the quality of clinical placements.
‘It means there are students graduating now who have not achieved the necessary number of hours or the full set of competencies. They are having to delay graduation until they achieve them and there is a lot of catching up to do.’
The NMC acknowledges there has been disruption. NMC executive director of professional practice Geraldine Walters says: ‘We recognise the pressures on services as a result of the pandemic, and the impact this has had on students and arrangements to support their learning in practice.’
Professor Walters says education providers are looking at innovative solutions, including the use of simulated learning to overcome the challenges. This includes the use of manikins and virtual reality wards, where students have to navigate a range of scenarios. Simulated learning was already in use before the pandemic but has become more widespread, with the NMC giving the green light to simulated learning being used for up to 600 of the 2,300 placement hours students are expected to accrue.
When all students are supernumerary, it is clear to staff that they are primarily there to learn
Picture credit: Neil O’Connor
The continued use of virtual placements will be determined as part of the regulator’s future standards review.
Changes are certainly possible, but whatever happens, Professor Walters says the regulator will ensure students get the ‘right support and supervision to learn and develop skills without compromising themselves or the safety of the people in their care’.
Nursing students being ‘used and abused’ on placements rcni.com/protect-supernumerary
Further information
RCN Position Paper on Supernumerary Status in the UK tinyurl.com/rcn-supernumerary
